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Special Edition on the Treatment of Trauma and Creative Arts Therapy
These stone sculptures represent how treatment strengthened one patient’s adult ego state so that, in turn, he could nurture his inner-child ego state.
A Model of Creative Arts Therapy:
Eight Essential Processes
“Art gave me the language to become emotionally literate... Art
therapy helped me bridge my current state to the traumatic events...
and gave me an opportunity to heal the younger self and liberate
the older self... I’m not sure the term ‘catharsis’ is strong enough
to describe the impact of my session. ‘Liberating’ would be a term
I would also use; the freedom from the deep wounds that were
destroying me. The wounds are still there, but I feel empowered with
the freedom to move on and to rebuild my life.” (Patient Graduate 1)
In Sierra Tucson’s Program for Sexual and Trauma Recovery
(PSTR), we are able to address, treat, and heal both trauma and
addiction. As a treatment team, we have worked with many
forms of grief and loss; childhood trauma; sexual harassment/
molestation/abuse/rape; domestic violence; torture; and traumas
related to accidents, natural disaster, terrorism, and war. We also
treat a myriad of compulsions and addictions to substances and
processes. Due to individual differences regarding types of trauma
and responses, treatment plans for patients in PSTR are individualized. The patient is seen as a whole individual, more than the
total sum of personality traits and diagnoses.
PSTR identifies and, in many cases, rectifies damage to the
psychological structures of the patient. The primary impact of
trauma on each individual’s systems of attachment and meaning
are processed through relationships to self, staff, and peers. The
center of our program is group therapy. It is through group
processes that the relational (conflicts with self and others) is
best addressed. It is through existential dialogue with group
members that the meaning of life and purpose are established.
Bessel van der Kolk references positron emission tomography
research of the brain when declaring the importance of incorporating creative arts therapy into treatment for those who have
experienced trauma (van der Kolk, 1996).
The creative arts therapy component of our program, (which
includes painting, drawing, collage, psychodrama, integrative
movement, mask-making, sculpture, and dance therapy) engages
the pre-verbal, nonverbal, metaphorical, symbolic, and right-brained
processes necessary to aid the amelioration of traumatic symptoms.
Research studies show that the creative arts are able to reach
difficult-to-treat patients, patients who have not faired well in
traditional talk therapies (Korlin, D., et al., 2000). When the
creative arts are provided, patients are more likely to remain in
treatment until therapeutic objectives are met and to describe
their experience more favorably (Pizarro, J., 2004).
Dr. Ericha Scott, primary therapist for the trauma group, is a
registered expressive arts therapist and a registered art therapist.
In 2002 Ericha was asked to teach the associate fellows in the
Program for Integrative Medicine at the University of Arizona how
to use the creative arts as a healing tool. Her model of creative arts
therapy, a succinct distillation of seven essential processes, emerged
from that effort and is a culmination of 20 years of professional
experience in the healing arts. Recently, she added one more
element to the model, now entitled “Eight Essential Processes.”
There is no all-encompassing theory that defines art therapy.
Rubin (1987) stated that such a theory will be born out of the
practice of creative arts therapy and will include aspects of
different theoretical disciplines. Ericha’s Eight Essential
Processes are authenticity, catharsis, projection, sublimation,
balancing locus of control, identification of developmental
ego states, integration, and transcendence.
Authenticity ~ Art is used to identify, explore, and express
emotions with integrity. The arts provide a safe ground for
(Continued on page 2)
In this Issue
Page
A Model of Creative Arts Therapy . . . . . . . . . . .
Letter from the Executive Director . . . . . . . . . . .
Quality of Life Workshops . . . . . . . . . . . . . . . . .
Psychotherapy as Transformational Experience . .
Summit for Clinical Excellence . . . . . . . . . . . . . .
Extended Family Program . . . . . . . . . . . . . . . . . .
Register Now at www.SierraTucson.com . . . . . . .
Meet Dr. Ericha Scott . . . . . . . . . . . . . . . . . . . . . . . .
1
2
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(Continued from page 1 ~ Creative Arts Therapy)
processing painful affect with color, line, texture, form, tone,
timbre, rhythm, flow, movement, and shape. As individuals
develop integrity and congruency with their emotions and
thoughts, they experience empowerment.
act of deliberating, deciding, and responding within our destined
nature” (King, 1969, p. 90). We have a choice in how we respond
to our fate and, thereby, shape our destiny. Whether or not one
believes in fate, attention to locus of control helps us determine
what we are able to control and what we need to accept.
Catharsis ~ An art form can be used to find a symbol that
closely represents the person’s inner world. Finding and
portraying this symbol provides relief. Catharsis includes a
purging process and a review of the person’s history with
attention to what is “me” or “not me.”
“Locus of control (LOC), a psychological construct developed by
Rotter (1966), refers to the manner in which an individual perceives
reinforcements or rewards. Reinforcement is seen as contingent
either upon one’s own behaviors, actions, efforts and skills or upon
the actions of powerful others, luck, fate and chance. A LOC continuum is thus formed with rewards being externally dependent at one
end and internally dependent at the other end.” (Rosal, 1993, p. 231).
Projection ~ The art piece is used as a mirror of self. The use of
projection as a creative therapy technique helps people bypass
cognitive distortions and gain insight. For example, a patient
creates a painting that is very chaotic and is able to recognize
how it is a reflection of his or her own chaotic life.
Balancing LOC is a bi-directional process, in that some may need
to internalize and others externalize more, thereby helping the
individual modify his or her own level of accountability or actions.
Sublimation ~ Kramer (in Rubin, 1987) states that to sublimate
is “to give symbolic vent to… pain” (p. 31). A Freudian definition
of sublimation would be to transform primitive urges. When a
safe place is created for trauma survivors and addicts, they are
able to channel negative energies into a creative process instead
of against the self or others.
Identification of Developmental Ego States ~ It is essential to
identify and honor the normative ego states within all of us. For
whatever reason an adult enters therapy, especially if in a crisis,
there is often a bridge to a younger self that experienced a similar
precipitating event at an earlier age. Due to the nature of art
therapy, this bridge is made and both dimensions of self have
Balancing Locus of Control ~ Martin Luther King, Jr., said that
life was a combination of fate and choice and that “freedom is the
(Continued on page 3)
Letter from the Executive Director
David E. Anderson, Ph.D.
much will be different.” CRC realizes that Sierra Tucson is an
extremely unique treatment center with a wonderful track record
of clinical success, and CRC is committed to keeping our treatment model in its entirety… and actually providing additional
resources to support and enhance our clinical services.
Dear Friends,
With great excitement, I share with you that, as of May 2005,
Sierra Tucson is under new ownership! After over 21 years of
providing his visionary and passionate leadership, our founder
and primary owner, Mr. Bill O’Donnell, decided earlier this year
that the time was right to pass on the reins to a new ownership
group. We are proud to announce that we are now a member
facility of CRC Health Group, Inc., based out of Cupertino,
California.
We continue to make improvements to our programs, our
physical environment, and also our website. To give you better
service, our website now provides customized Registration
Forms for the many events that Sierra Tucson hosts. As always,
you may check our website at any time for upcoming events,
and now you can quickly register online for most activities!
Visit the “Events” section of www.SierraTucson.com for an
event near you!
CRC is committed to providing comprehensive treatment for
persons with chemical dependency and behavioral health
problems. CRC emphasizes the physical, mental, emotional, and
spiritual transformation to assist individuals in taking responsibility for their own recovery and well-being. Because CRC
consists of many types of facilities, they can offer a continuum
of seamless services for both adults and adolescents, including
inpatient care, partial/day treatment, intensive outpatient groups,
therapeutic living/half-way house environments, aftercare centers, and detoxification centers. This means that Sierra Tucson
will have more resources to offer to the wide variety of individuals’ needs. I invite you to visit www.CRChealth.com to
learn more about CRC’s mission and resources to create new
beginnings.
We encourage you to contact us if you have questions. Our
website also provides contact information for the clinical
outreach coordinator in your region. Click on “Professional
Resources,” and then “Outreach” to find the coordinator in
your area, or call our Intake Department at 1-800-842-4487.
Thank you for your continued support. May
you find delight in each day’s blessings.
Sincerely,
So, what else does this mean for our patients, referents, management, and staff? The answer, in very practical terms is, “Not
David E. Anderson, Ph.D.
Executive Director
2
(Continued from page 2 ~ Creative Arts Therapy)
the opportunity to heal. These multiple selves are revealed in
the variety of maturational stages of art produced by the person
in therapy. During a disinhibiting stage, the patient’s art may
look very childlike. This experience of multiple selves (and roles
or archetypes) and the linking bridge needs to be consciously
identified and addressed by the therapist.
how to draw. By focusing on sorrow and loss in her drawings,
Elizabeth was cured of depression within six months. Her depression never returned, and she ultimately exhibited artwork and
her story at the Smithsonian Museum (Lambert, 1995).
The directive for the blind contour self-portrait process is for the
artist to draw while looking in the mirror, but not at the paper,
except to periodically orient or register the image. It is hypothesized that this drawing discipline forces the patient to use
both sides of the brain. If this is so, the drawing technique would
evoke a bilateral processing of trauma, not unlike what is achieved
by Eye Movement Desensitization and Reprocessing (EMDR).
This concept may explain the power of the exercise. Please refer
to Figure 1 to see the image described below.
Integration ~ It is essential to identify disparate parts of self
such as young and old, hopeful or depressed, rigid or wild, and
integrate them. Another way to describe this process would be
to integrate polarized energies, which can be done symbolically
through the use of color or other media. Accomplishing integration is an ultimate task in developing maturity, balance, and
wholeness. Integration is one of the curative processes.
Transcendence ~ This is the ability to transform self, others, or
Case Example: The patient used this exercise to process verbal
situations through a spiritual connection to a higher source. It
abuse perpetrated by a deviant religious group. The artwork
is well documented that while producing art, many experience
was entitled “Jezebel,” a name she had been called as a deroaltered states of consciousness or hypnotic states (May, 1975).
gatory reference to her sexuality. An adolescent at the time, she
In this state, the experience of intentionality (as described by
internalized the messages of shame regarding her budding
phenomenologists) can be realized. This is the ability to investisexuality and acted out in ways that were self-destructive, even
gate the full experience of things without preconceived notions
dangerous. As she began to recognize and identify normative
or reductionistic models of mankind (Betensky, in Rubin, 1987).
sexual development, she asked the question, “Why would God
This trance state provides a threshold for crossing into realms of
give me passion if it is a bad thing?” As she processed the pain
what can be referred to as the cosmos, the
of the abusive (and unfair at the time) title
collective unconscious, the inner self, or
of Jezebel, she began to realize that she
Figure 1
God, depending upon the person’s spiritual
didn’t have to live out a role assigned to
or religious orientation. It is here that we
her by someone else. The patient dialogued
transcend the limitations of humanness and
with a representation of herself as Jezebel
embrace multiple possibilities and greater
and offered to this assigned role educapotentialities, i.e., miracles.
tional information, forgiveness, and a new
set of sexual boundaries and values.
Finally, it is through the process of making
art that the artist/patient embraces the
Brief Description of Sandplay Therapy ~
cyclic process of creation, preservation,
Dora Kalff, one of the first theorists and
dissolution, and re-creation. May (1975)
practitioners to use miniature figurines,
said, “Every act of creation is first of all an
referred to her unique approach as “western
act of destruction” (p. 63) . This process
meditation.” She was most influenced by
helps the artist accept the world in nonCarl Jung, Margaret Lowenfeld, and a Tibedualistic terms and gain acceptance of even
tan monk refugee who lived in her home for
the most difficult situations.
seven years. Dora brought to the practice
of sandplay therapy a combination of
Although the Eight Essential Processes
Neumann’s theory of personality development, Carl Jung’s concept
might be considered a stage theory, it isn’t strictly sequential. It
of active imagination, and spirituality. Dora’s therapeutic directives
is more like a multidimensional game of billiards. It may be
for the process were very simple. She told patients to make a picture
disputed which stages are more important—whether the stages
with the sand and figurines and then tell the story portrayed in
are just supportive or curative.What is most important is that all
the sandbox (Kalff, 1980). The following words of a Sierra Tucson
stages work together.
patient best describe his experience of a sandplay therapy session.
Examples of patients’ creative arts therapy ~ The three
Please refer to Figure 2 to see a photo of the sandbox.
modalities described in this article include Blind Contour SelfCase Example: “To be honest, when Ericha first told me I was
Portraits, Sandplay Therapy, and Psychodrama.
scheduled for a sand tray therapy session, I was skeptical. My
Brief Description of Blind Contour Self-Portraits ~ Elizabeth
initial thought was that it seemed pretty silly to put a bunch of
Layton was the first person to use blind contour drawings in a
figurines and toys in a sandbox. However, at the time I was
therapeutic way. Elizabeth began drawing for the first time at
suffering from so much mental and emotional pain, I was open to
age 68 while depressed over the death of her alcoholic son.
just about anything. There have been so many traumas in my
With her sister’s urging, she took a drawing class and studied a
life, from being molested as a child, to finding my infant son
blind contour drawing technique. The blind contour drawing
dead in his crib, to dealing with numerous suicides, and providing
(Continued on page 4)
technique is widely used in art programs to teach new students
3
(Continued from page 3 ~ Creative Arts Therapy)
CPR to 13 different people. My life was a total mess, my marriage
was in big trouble, and suicide seemed like the only viable
option. When I created the sand tray, I was surprised at how I
felt. I started placing items in the box, including a baby in a crib,
and various other figures that represented the traumas in my
life. I placed the figures in chronological order around the box,
ending with my wife and children. It was difficult to relive these
traumas and to see them in such a vivid picture, but as I stared
at the box I began to realize that I needed to deal with the past
trauma, because I could not make it go away. What I most realized
was that I needed to get better because I wanted my family
back, and suicide was no longer an option.”
into his heart for safety. Tearfully, the patient described how he
felt more whole and complete. As the patient processed his experience of the psychodrama, he reiterated something he had always
known, which was that his father had been a hero by rescuing
their physical bodies from the fire. More importantly, he recognized that he, himself, was a hero for rescuing his inner-child
ego state emotionally, physically, and spiritually from the flames
of misappropriated guilt. At this point, the patient, who had
been emotionally frozen, began to weep deeply from relief.
Conclusion ~ As healers, we are called to identify and treat
the grief, loss, and trauma that fuels a
compromised lifestyle. The Eight Essential
Processes, as a model for creative arts therapy, may be used to structure one session,
as well as short-term or long-term treatment.
Liberation isn’t a quick fix, like a drug or an
addiction. It is a beautiful, creative process
of self-discovery that manifests throughout
one’s lifetime. Below is a quote from a recent
graduate of the trauma group:
Figure 2
Brief Description of Psychodrama ~
Psychodrama can be described as using
peers and props to create a multidimensional
visual of the patient’s presenting problem,
trauma, addiction, or relational dynamic.
Moreno, the creator of psychodrama as a
psychotherapeutic intervention in 1921, said,
“Psychodrama puts the patient on a stage
where he can work out his problems with the
aid of a few therapeutic actors” (Moreno in
Dayton, 1994, p. 10). The protagonist patient
(main character or leading role) is instructed
to select patient peers to play various individuals or parts of self (auxiliaries/doubles).
“I am great!! I never thought I could wake up
each morning and be happy as well as thankful
for the person I am and the life I live. I’ve been
telling any one who will listen about my experience. NO MORE SHAME!!! I miss being there
some days when it gets a little scary or hard, but
overall I am beyond grateful for the staff and
friends I made at Sierra Tucson. I have focus and clarity for the first
time in my life. My trauma will always be a part of me and my
memories, but I see now it no longer owns me, my decisions, or my
perspective on life.” (Patient Graduate 2)
Case Example: Although only 8 years old at
the time, the patient carried misappropriate feelings of guilt and
shame from a childhood experience when his house burned to the
ground. He requested a psychodrama due to his difficulty accessing
grief. Just before the house caught on fire, he described himself as
struggling, wiggling, and fussing while his mother tried to wash
his hands. He thought his mother was frustrated with him for
fidgeting. Somehow a candle was knocked over, setting the curtains
on fire. The next thing he remembered was hearing his father yelling
for them to get out of the house. He remembered seeing his father
run through the smoke, pick up his mother, who was holding him
in her arms, and carry both of them out over the flames. The patient
saw his father as the hero and himself as the “guilty one.” During
the enactment by his peers, as he watched the scene played out
before him, he regressed into terror. He hunched over, his toes
pointed inward like a small boy, and he appeared frozen—in shock.
With direction from the therapist, he was able to ground himself.
With the patient’s permission, the scene was replayed again, but
this time the patient was asked to rescue himself emotionally and
spiritually from the event. He jumped into the flames (symbolically
represented by whirling scarves), took his inner child by the hand,
and led him to safety. He comforted the double (a peer representing
his inner-child self), and explained that he was too little to have
rescued his family, “Your legs were too small to carry anybody.”
He went on to say, “It wasn’t your fault that a fire was started in
our home or that the house burned down. It was Dad’s job to help
us; he was a grown up.” As the patient continued his dialogue
with his double (inner-child self), he was asked to switch roles
back and forth until it was clear that the patient harbored no
more false guilt. The patient then integrated his child ego state
By Ericha Scott, Ph.D., M.Ed., NCC, ATR, REAT, ADC-III.
With permission, excerpts were taken from Integrating the Creative Arts
into Trauma and Addiction Treatment, by Ericha Scott and Second Author
Carol Ross in Psychological Trauma and Addiction Recovery, edited
by Bruce Carruth, Ph.D., to be published by Haworth Press in 2006.
REFERENCES
Dayton, T. (1994). The drama within: Psychodrama and experiential therapy. Deerfield
Beach, FL: Health Communications, Inc.
Kalff, D. (1980). Sandplay: A psychotherapeutic approach to the psyche. Boston: Sigo Press.
King, M. L. (1963, 1969, 1977, 1986). Strength to love. Glasgow, Great Britain: William
Collins Sons & Co.
Korlin, D., Nyback, H., and Goldberg, F. S. (2000). Creative arts groups in psychiatric care:
Development and evaluation of a therapeutic alternative, Nord J Psychiatry, 54, 333-340.
Lambert, D. (1995). The life and art of Elizabeth “Grandma” Layton. Waco, Texas: WRS Publishing.
May, R. (1975). The courage to create. New York: Bantam Books.
Pizarro, J. (2004). The efficacy of art and writing therapy: increasing positive mental health
outcomes and participant retention after exposure to traumatic experience. Art Therapy:
Journal of the American Art Therapy Association, 21 (1) 5-12.
Rosal, M. L. (1993). Comparative group art therapy research to evaluate changes in locus
of control in behavior disordered children. The Arts in Psychotherapy, 20, 231-241.
Rotter, J. B. (1966). Generalized expectancies for internal versus external control reinforcements. Psychological Monographs: General and Applied. 80 (1, Whole No. 609).
Rubin, J. A. (Ed.). (1987). Approaches to art therapy: Theory and technique. New York:
Brunner/Mazel.
Scott, E. H. (1999). The body as testament:A phenomenological case study of an adult woman
who self-mutilates. The Journal of Arts in Psychotherapy, Vol. 26, No. 3, 149-164.
Scott, E. H., (Speaker). (2002). Expressive arts therapy: The seven essential processes. On
Mind-Body Conversations (CD No. 2), Tucson, AZ: University of Arizona Associate
Fellowship in Integrative Medicine.
Scott, E. H. & Ross, C. (To be published 2006). Integrating the creative arts into trauma and
addiction treatment: Eight Essential Processes. In Psychological Trauma and Addiction
Recovery. New York: Haworth Press.
van der Kolk, B. A. (1996). The complexity of adaptation to trauma self-deregulation, stimulus
discrimination, and characterological development. In B. A. van der Kolk, A. C. McFarlane,
& L. Weisaeth (Eds.). Traumatic stress, 182-213. New York: Guilford Press.
Wilson, M. (2000). Creativity and shame reduction in sex addiction treatment. Sexual
Addiction and Compulsivity, 7, 229-248.
4
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5
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November 6-11, 2005
Sierra Tucson’s website is now enhanced
to better accommodate your needs! You
may check our website anytime for the
latest information on our professional
and alumni events... then click on the
“Register Now” button to sign up online!
SIERRA TUCSON ®
39580 S. Lago del Oro Parkway
Tucson, AZ 85739
1-800-842-4487
www.SierraTucson.com
“Compassionate Care, Clinical Excellence”
S I E R R A
T U C S O N
P R O G R E S S
SUMMER/FALL 2005
© Copyright 2005 Sierra Tucson, Inc.
Meet Ericha Scott, Ph.D., M.Ed., NCC, ATR, REAT, ADC-III
Primary Therapist, Program for Sexual & Trauma Recovery
Director. She has designed many experiential, therapeutic workshops
and presented at state, national, and international mental health
conferences. She produces a television show, “The Freedom of Art,”
which is a forum for dialogue about art’s meaning and contribution
to our world, and has written a chapter on “Integrating the Creative
Arts into Trauma and Addiction Treatment” with second author
and Sierra Tucson staff member Carol Ross, M.A., LPC, CADAC,
ICRC, for a textbook to be published in 2006 by Haworth Press.
Before Dr. Ericha Scott joined Sierra Tucson’s staff in April 2004,
she referred clients to Sierra Tucson from her private practice.
With 20 years of professional experience, she sees her role in the
treatment of trauma as a “wonderful process of bearing witness
to the healing of brokenness.”
In 1997 Dr. Scott moved to Tucson for doctoral studies and an
internship at the University of Arizona with Gary Schwartz, Ph.D.,
a Professor of Psychology, Neurology, and Psychiatry and an
expert in repression, spirituality, and energy psychology.
Dr. Scott’s commitment to helping others was intensified through
her own life’s events. She married Randy Tufts, a co-discoverer
of Karchner Caverns in southern Arizona, three days before his
bone marrow transplant. “This good, kind, brilliant, and funny
man died 1½ years after we married, and I still miss him,” she
says. Through her personal experience of grief and loss, Dr. Scott
relates more deeply with patients.
Dr. Scott is a nationally certified counselor, registered art therapist,
registered expressive arts therapist, diplomat addictions counselor, and
holds licenses in three states. She received her doctorate in Clinical
Psychology and Creative Arts Psychotherapy from Union Institute;
post-master’s Graduate Art Therapy Certificate from the College of
Notre Dame; M.Ed. from Florida Atlantic University; and completed
additional studies in fine arts at Sarah Lawrence College in Lacoste,
France. Dr. Scott has been a board member for the International
Expressive Arts Therapy Association and Allen Street Gallery. Her dissertation, which was a phenomenological study of self-mutilation, a
long-term sequela of trauma in adult dissociative-disordered women,
was published in the Journal for the Arts in Psychotherapy.
Dr. Scott received training from Dr. Renee Fredrickson, a mentor
for John Bradshaw, and is also certified as an Interfaith Spiritual
“People ask me how I can listen to horror on a
daily basis,” Dr. Scott reflects. “It is such a
powerful thing to behold as people reclaim their
connection to self and spirit. It is joyful to see the
light come on—the spark return to eyes that have
been dull and blank from despair. As wounds of
the past are healed, patients become more whole
and a new life begins. I was born to do this!”
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